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2 Month Visit - Worried about Weight Gain % Drop

We went for our two month doctor's visit today - my exclusively breastfed baby dropped from the 69th percentile to the 47th percentile since his last visit at 4 weeks. The doctor was slightly concerned but said that since he looks healthy, she will just do another weight check at 3 months. He was 9lbs at birth and had been tracking in the 69th percentile over 4 visits.

Just for some history: he's fed on demand although he can be fussy at the breast; my supply is good; he measured today in the 77th percentile for height and the 81st for head circumference. I will add that we are battling what appears the be a reflux problem with coughing, congestion and a lot of restlessness while sleeping.

Should I be worried about the weight drop? Two months was exactly where the wheels fell off the wagon with my daughter. She was 9lbs 2oz at birth and at the two month visit, our prior pediatrician demanded that I supplement with formula because she also experienced a large percentage drop. That was the beginning of the end of breastfeeding with her and I desperately don't want that to happen with my son.

Re: 2 Month Visit - Worried about Weight Gain % Drop

Is your LO fed on demand, and does that add up to at least 8 nursing sessions per day? If so, I don't think I'd be concerned about the percentile drop. Some babies are just genetically destined to be slender for their height, and when a baby's weight percentile drops but his height and head circumference stay on track, I don't see a reason to think that there's a problem. There's a phenomenon called "catch-up/catch-down" growth that often happens, in which a baby follows one growth trajectory inside the womb, where mom's body controls growth to a greater extent, and a different growth trajectory outside, where the baby's genetics take over. So it's not uncommon for babies to be born large and then lean out, or to be born small and then chunk up. The fact that you've had 2 babies follow the same growth pattern makes me think that they are just following their genes.

The one thing that concerns me is the reflux angle. Some intensely reflux-y babies learn that eating results in hurting, and start avoiding it.

Re: 2 Month Visit - Worried about Weight Gain % Drop

He typically nurses 8-10 times per day and hasn't had a decline in dirty diapers, so I hadn't even anticipated a % drop at this visit. Interesting thought on reflux-y babies avoiding the breast. For the past two weeks, as the reflux symptoms have been worsening, there has been more "fights" about feedings. He pops off the nipple after the letdown, kicks his feet, arches his back and generally keeps his feedings very short unless he is sleepy. Are there any positions or strategies for nursing that can help combat the reflux symptoms? He isn't terribly spitty-uppy, but I can tell he's uncomfortable because he often cries out in his sleep and he coughs on the liquid backing up. Right now, we've settled into the craddle hold (this is where he fights me the most) or the side-lying position for nursing. Are there better options for reflux?

Re: 2 Month Visit - Worried about Weight Gain % Drop

No, no medication at present. The doctor said she is hesitant to use antacids except in extreme cases because it just removes the acid from the stomach but doesn't stop the regurgitation. The acid is what causes the pain, but the regurgitation is the real core of the problem. Medication is something to consider if the weight gain further declines.

Re: 2 Month Visit - Worried about Weight Gain % Drop

Right now, we've settled into the craddle hold (this is where he fights me the most) or the side-lying position for nursing. Are there better options for reflux?

I have had 2 babies 'diagnosed’ with reflux. I put diagnosed in quotes because reflux can easily be misdiagnosed. So I am not 100% sure the issue was reflux in our case. We never had weight gain concerns, but painful wet burps, that kind of thing. Anyway, For my oldest we did a ppi med, not an antacid. It seemed to help a bit, but I was adopting other measures to help as well so…? Some mothers do find reflux improves dramatically once baby is on the right medication.

For my 2nd refluxy son, we managed to manage the issues without medication by the following-
I would nurse in a position so his head was above his tummy. He was a big baby, so I would sit on the couch, in a slightly reclined posture, and his feet would dangle down between my legs, or I would put him at an angle with feet to my side, but always with head above tummy. So like the position illustrated here, http://www.llli.org/docs/00000000000...astfeeding.pdf but with mom more upright. I suggest playing around with this 'laid back' posture in general.

Other things that helped:
Holding baby upright (head above tummy, snuggled into my chest or shoulder) after feedings for as long as I could, at least 30 minutes.
After nursing in a sidelying position at night, I would sit/stand him up, kind of draped over my side, to get the same head above tummy effect without having to sit up myself.
Burping during or just after feedings sometimes helped
Wearing baby in a sling in an upright position
Avoiding (as much as possible) keeping baby for long in a 'c' position such as in a car seat, bouncy chair, etc.
Nursing as frequently as baby would. Short, frequent feedings seem to help refluxy babies sometimes.